Members of Congress will soon be heading home for their August district work period where they will be meeting with—and listening to—their constituents. There is not a better opportunity for you to turn up the heat by reminding them that there is still unfinished work on important health care issues, including looming cuts to physician Medicare payments and fixing the cumbersome prior authorization process.
Tell Congress to get our health care system back on track by reviewing the following issue links:
Physician Medicare payment cuts: Late last year, physician advocates from across the country united to successfully persuade Congress to delay a “perfect storm” of Medicare payment cuts that, if enacted, would have severely impeded patient access to care.
Unfortunately, if Congress does not act by the end of the year, these delayed cuts and some new ones, will take effect in 2023 and cause serious disruption to physician practices.
It is clear that Congress must work with the physician community to develop long-term solutions to the systemic problems with the Medicare physician payment system and preserve patient access by passing legislation. In the meantime, policymakers need to address the immediate problem.
Before the end of the year, the AMA is asking Congress to:
- Extend the Congressionally enacted 3% temporary increase in the Medicare physician fee schedule
- Provide relief for an additional 1.5% budget neutrality cut that is planned for 2023
- End the statutory annual freeze and provide an inflation-based update for the coming year
- Waive the 4% PAYGO sequester necessitated by passage of legislation unrelated to Medicare
Use these materials and contact your members of Congress to let them know the Medicare physician payment system needs reform to become a more sustainable, value-based system that better meets the needs of patients and physicians.
- The need for Medicare payment reform (PDF)
- Congress must stop Medicare payment cuts triggered by budget neutrality (PDF)
- The Medicare physician payment system needs annual inflation updates (PDF)
- Medicare alternative payment models (PDF)
- The principles: Characteristics of a rational Medicare physician payment system (PDF)
For additional information, view the recording of “Medicare payment principles: A vision for reform,” the latest in the AMA’s Advocacy Insights webinar series.
Prior authorization: Physicians complete an average of 41 prior authorizations per week. This unnecessary burden amounts to roughly 13 hours weekly that physicians and their staff must spend on administrative work instead of seeing and treating patients. If an insurance plan covers a treatment that would benefit a patient, physicians should not have to waste time ensuring access to it.
Further complicating matters, the criteria used for prior authorizations are unclear. Physicians rarely know at the point-of-care if the prescribed treatment requires prior authorization, only to find out later when a patient’s access is delayed or denied. This ineffective system can cause unnecessary tension in the physician-patient relationship and negatively impact patient health.
Luckily Congress has already taken steps to address this by introducing the Improving Seniors’ Timely Access to Care Act (H.R. 8487) which would require Medicare Advantage plans to adopt transparent PA programs that adhere to evidence-based medical guidelines and hold plans accountable for making timely PA determinations and providing rationales for denials.
Momentum is building on H.R. 8487 and, with enough grassroots pressure in August, we can get it across the finish line when Congress returns in the fall. More information on this legislation is contained in the National Update section.
With only a handful of legislative days left this year, please join us in the fight to get our health care system back on track. Take action on these critical issues and look for opportunities to get in front of your members of Congress and their staff over the August recess. Visit physiciansgrassrootsnetwork.org for updated resources including policy points and information on public events that lawmakers are planning. Also, please keep the AMA informed on your activities throughout the month by filling out this brief form.
Remember, elections are approaching and time is running out for this Congress to take the critical steps required to help physicians and the patients they care for. Please do your part by answering this urgent call to action.